A Biocultural Approach to Breastfeeding

The biocultural model is
useful for understanding breastfeeding and helping mothers to breastfeed.
This model comes from anthropology, the social science which studies
the relationship between biology and culture. Culture is defined by
anthropologists as a people's way of life. Anthropologists consider
humans to be biological organisms who constantly adapt to and modify
their environment through culture.

For years, anthropologists
have been collecting data on breastfeeding, but their findings have
been largely ignored. Medical researchers studied every milk-producing
mammal except for Homo sapiens. Anthropologists amassed enormous amounts
of information about breastfeeding in human societies where the vast
majority of women still breastfed, but until recently the opinion of
the medical profession and of the general public about that data could
be summarized as: "They are savages! What can we possibly learn from
them?"

Timeless and Trustworthy

Anthropologists maintain
that a process which has nourished human children since the earliest
known humans must work and have advantages for mothers, infants, and
the whole species. Such a process deserves respect. Successful lactation
has usually meant survival for mammalian infants and an opportunity
for them to grow and reproduce.

From the understanding of
natural selection and adaptation has come a new area of study called
evolutionary medicine (Nesse and Williams 1994). This new way of understanding
health and illness, normality and abnormality, does not ask "What is
wrong with this body?" but rather "What is it about being human that
makes our bodies work the way they do?" A biocultural approach provides
a powerful argument for why we nurse our babies, why our babies behave
the way they do, and why mothers, babies, and fathers respond in certain
ways to one another.

A biocultural approach is
not a "back to nature" approach, it is the realization that culture
and biology interact. Culture is what makes us human. Therefore, it
is difficult to say what is "natural" for humans; culture plays so large
a role in the decisions we make. For example, many mothers wonder how
long they should nurse their babies and what the natural, or normal,
age to wean is. An anthropologist would say that the timing of weaning
is culturally defined and varies from one culture to another, ranging
from birth (no breastfeeding) to approximately seven years. Sometimes
there is also a gender difference; in some cultures boys are allowed
to wean at a later age than girls. A similar question arises over the
issue of tandem nursing. Bioculturally speaking, tandem nursing is uncommon.
Instances of tandem nursing are extremely rare in the ethnographic literature.

Biocultural Support for
Extended Nursing

Human milk is low in fat
and protein. It is relatively high in carbohydrates, especially lactose.
Lactose is the sugar that feeds our large brains. This explains why
human milk has nearly twice as much lactose as cows' milk--cows are
not expected to learn algebra! Like other primates, our infants are
born relatively undeveloped, nurse frequently, and grow slowly (Stuart-Macadam
and Dettwyler 1995). Primates nurse for a significant portion of their
lives, partially because they have such long periods of infancy. In
Breastfeeding: Biocultural Perspectives, Katherine Dettwyler
says:

If humans weaned their offspring
according to the primate pattern, without regard to beliefs and customs,
most children would be weaned somewhere between 2.5 and 7 years of age....Age
at quadrupling of birth weight, and six times the length at gestation,
would be more accurate "rules of thumb" to use based on studies of large-bodied
nonhuman primates....Sharply curtailing the duration of breastfeeding
below what the human child has evolved to expect, has significant deleterious
health consequences for modern humans.

Of course, humans do very
little without regard to belief systems and customs. But this type of
comparative study is helpful in countering the argument that children
who nurse for an extended period of time are abnormal or that the mothers
who continue to nurse them are encouraging dependency or are nursing
for their own selfish reasons.

Cultural behavior can also
be spectacularly non-adaptive. In 18th-century northern Europe, it was
considered low-class to feed babies at the breast or even to feed them
milk. Mozart considered it proper that his babies would be raised as
he was--on sugar water. Four of his six children died in the first three
years of life primarily because as infants they were fed mainly sugar
water. The terrible health that took Mozart's life at a tragically young
age may have been related in part to his "proper" Austrian diet as an
infant.

Infant-Parent Co-Sleeping

Infant-parent co-sleeping
is another issue where biological data clarifies a cultural pattern
(Stuart-Macadam and Dettwyler 1995). Human infants are so immature and
need to feed so frequently that it should surprise no one that most
human infants, in most places and at most times, have slept with their
mothers and often, with both parents. This was still the pattern in
the United States until about 75-100 years ago when parents began to
be warned about the dangers of sleeping with their babies. Popular infant
care books warned about the danger of sexually stimulating the infant
by putting him in bed with the mother. Some experts warned that sleeping
with infants predisposed them to homosexuality. The possibility of "overlaying,"
or inadvertently smothering the baby, was spoken of in very serious
tones. Ironically, most of the parents who read these books had slept
with their parents! The good sense of generations of families to ignore
many of these reports has been supported by the work of anthropologist
James McKenna. In a carefully planned and executed study, he observed
mother-infant pairs sleeping in a laboratory environment. The laboratory
environment, of course, is certainly not a normal way to sleep, but
the ethical and logistical problems of observing mother-infant co-sleeping
in the home makes the laboratory situation acceptable. The study was
a controlled one which observed each mother-infant pair while both co-sleeping
and sleeping separately. Along with other related studies, the research
indicates:

In situations where mothers
breastfeed, do not smoke, and keep their infants next to them for nocturnal
sleep, SIDS death rates appear to be extremely low (Stuart-Macadam and
Dettwyler 1995).

Co-Sleeping and SIDS

No one suggests that breastfeeding
and/or sleeping with infants will entirely eliminate the complex causes
of Sudden Infant Death Syndrome (SIDS), but research suggests that they
are an important part of SIDS prevention. Because of their immature
nervous systems, infants do "forget" to breathe at times. This may be
related to death from SIDS. However, breastfed infants wake to nurse
frequently, which probably keeps them from sleeping too long and too
deeply to experience breathing problems. Also, they have a tendency
to imitate the breathing of nearby adults, which can keep them breathing.
If they stop breathing for an instant the difference in breathing patterns
may cause the mother or father to shift or move, which in turn may stimulate
the baby to take a breath. Infants face their mother much of the time
when they sleep with her and the exhaled carbon dioxide from her breath
also may stimulate the baby to breathe.

There are some other hypothesized
benefits of co-sleeping. If some women do vary in milk production capability
(which seems likely), extending the part of the day when baby can breastfeed
would increase the baby's intake. The same may apply to the intake of
immune factors, since production of these probably also varies from
woman to woman.

Culture-Induced Colic?

Infants sleep, but they also
cry; some cry a great deal. Ronald Barr, a pediatrician at McGill University
in Montreal, Quebec, Canada, has studied infant crying patterns. He
discovered that infants with supposed colic do not cry more often or
at particular times of the day; they just cry longer each time. His
suggestion is that such crying is normal but may be prolonged by modern
practices such as longer intervals between feedings. Dr. Barr compared
the results of a study done of the !Kung of South Africa with the typical
ways in which American and European infants are handled and fed. The
!Kung carry their babies with them constantly and feed the babies whenever
they cry. Babies may be fed three or four times an hour for a minute
or two at each feeding (Konner and Worthman 1980). In the United States,
the average number of feedings in a day is seven and the average length
of time between feedings is three hours. So Barr asked American mothers
to carry their babies at least three hours a day. These mothers reported
that their babies cried only half as long as babies whose mothers did
not carry them for the extra three hours (Barr 1989).

Insufficient Milk Syndrome

Any mention of crying in
breastfed infants brings us to an issue that has appeared recently (and
sensationally) in the popular press: insufficient milk. A common reason
for discontinuing breastfeeding in the US is, "I don't have enough milk."
While there are instances of a genuine inability to produce enough milk,
it often turns out that the one who is concerned about the breastfeeding
is not the mother, but a relative or friend who argues "If that baby
was getting enough to eat he wouldn't be doing all that crying."

What about insufficient milk
supply? The issue has appeared in the anthropological literature for
some time. In 1980, Gussler and Briesemeister published an article arguing
that the feeding patterns dictated by life in urban, industrial societies--infrequent
feedings, lasting for long periods of time--actually caused women to
produce less milk. In response, Greiner, Van Esterik, and Latham (1981)
argued several hypotheses to account for the insufficient milk syndrome.
These focused on the introduction of artificial feeding and, therefore,
less nipple stimulation, as the real cause of insufficient milk:

When women or health workers
in close geographical proximity share the belief that insufficient milk
is a common phenomena, they may become acutely watchful for signs of
it. Thus they may interpret normal physiological events in the mother
(e.g., cessation of milk dripping from the breasts) or non-hunger-related
crying as signs of insufficient milk. Milk company promotional activities
may have initiated or furthered the belief that insufficient milk is
common and in other ways undermined mothers' confidence in their milk
supply.

In short, breastfeeding occurs
above the eyebrows as much as or more than it occurs in the mammary
glands. The word "insufficient" is like the word "inadequate"--once
it has been directed at a mother it can never be retracted, and her
confidence in her body's ability to nurture and nourish at the breast
often plummets.

Are there biological reasons
for low milk supply? There could be, simply because biological diversity
is such an important factor in all of life. Breasts and nipples come
in all different shapes and sizes, which is one reason for concern when
nipples and breasts are vigorously "assessed" before the baby is even
born. Babies have different shaped mouths, different sucking patterns,
and different levels of physical strength. What looks to the analyst
like small size or odd shape may be perfect for a given baby. Even when
a newborn and his mother struggle a bit with breastfeeding at the beginning,
it is important to remember that babies grow. Facial structure changes.
Muscle strength develops. Never underestimate the power of a mother
and baby to find a position that works well for them. McKenna and Mosko
(1993) discovered just this when they watched co-sleeping infants positioning
and repositioning themselves with respect to their mothers, mostly to
achieve a position to make nursing easier. A variety of studies have
shown that infants can regulate their intake volume and the amount of
fat in their feedings. There is evidence of infant-led variation in
the degree of breast emptying, the length of feedings, and the interval
between feedings (Stuart-Macadam and Dettwyler 1995). If a mother and
infant are encouraged to find a pattern that suits them, they are less
likely to experience any problems with milk supply.

Which Side First?

Women in traditional societies
tend not to nurse in the same way as women in modern industrial societies
in another respect: They pay very little attention to which breast baby
nursed from at the last feeding. When baby cries he is picked up and
nursed briefly on whichever side is convenient (Stuart-Macadam and Dettwyler
1995). It is interesting to note that in most women the right breast
is smaller and most humans are right-handed. Size of breast does not
predict quantity of milk produced, but there are often asymmetries in
breast milk output, even if there is no obvious bias in breast use.
The Koran tells women to start every feeding on the right breast; this
probably has more to do with ideas of ritual purity than concern with
asymmetrical supply, but it is certainly one way to deal with variation
in milk supply. Newborns often go through a phase of preferring one
breast over the other, often the left, but this usually passes. Of course,
it is a very poor idea for a mother to nurse exclusively at every feeding
on the same breast. Milk supply is very likely to be affected. Women
are worried that they will look "lopsided" if they nurse twice in a
row on the same breast, but it is rare for a woman's breasts to be the
same size and shape. Most of us are unaware of this until we breastfeed,
when we begin to look at our breasts in a different way and at a different
angle.

Weighing the Evidence

Flexibility is the secret
to successful breastfeeding. Many people are uncomfortable with flexible
patterns that permit the mother and infant to find workable solutions
to breastfeeding challenges. But breastfeeding is an art, not a science;
there are few things that work for all mothers and all babies everywhere
all the time (Stuart-Macadam and Dettwyler 1995).

Conversely, excessive rigidity
often makes breastfeeding impossible. At various times and places throughout
history, there was a tremendous emphasis on rigid practices in breastfeeding.
Babies were weighed before and after each feeding to regulate the amount
of milk consumed by the infant. Inaccurate weighing procedures were
common. Not surprisingly, few women reported feeling a let-down and
breastfeeding rates fell dramatically. This is not to suggest that babies
should not be weighed and measured. Babies need to be weighed and measured
occasionally to document growth. However, standards of growth are sometimes
too doctrinaire and do not take population and individual differences
into account.

Nature or Culture?

An emphasis on the biocultural
along with examples from cross cultural studies may lead some to think
that there is one perfect "natural" way to nurse a baby or raise a child.
It is tempting for nursing mothers living in a society which is not
very supportive of breastfeeding to fantasize about some perfect society
where all babies are born into a warm and supportive environment, where
breastfeeding is the only way to feed a baby, and weaning is never mentioned.
Such a society does not exist. We live in an imperfect universe and
our societies reflect that reality.

Cultures are more alike than
anyone can imagine--and more different than a person can possibly believe.
Birth may occur in a beautiful, comfortable environment, but in many
cultures colostrum is considered unfit for babies and the mother may
be forbidden to nurse until the colostrum begins to change to milk.
Children may nurse until age three, but among the Dinka, the child then
is taken to live with his grandparents in another village for a period
of time. He or she may nurse until age six in some places, but among
the Palau, the child then is abruptly forbidden to nurse and his cries
and entreaties are ignored. A baby may be biologically programmed to
sleep with his parents, but his culture may have a rule that says that
on the day the new baby is born he must begin to sleep by himself. Early
solids may be discouraged, but in many African cultures, certain protein-rich
foods are not considered appropriate for toddlers, which is the beginning
of a struggle with protein-deficiency diseases that some do not survive.
Concepts like attachment parenting and natural weaning are beautiful
concepts to many mothers, but to an anthropologist, they are cultural,
not biological, in nature.

In every culture there is
much to admire and emulate and much that others would reject. One of
the benefits of life in a large, heterogeneous society is a diversity
of customs and belief systems which provides parents with a range of
child rearing choices. It's up to them to decide what best meets the
needs of their family.

About the Author: Judithe
Thompson teaches Anthropology and Political Science at the University
of Rio Grande, Rio Grande, Ohio, where she is also Co-Director of the
Honors Program. Judithe and her husband (and fellow anthropologist)
Barry are the parents of Alta, 20, and Chrys, 18. She is Area Professional
Liaison for Ohio/West Virginia and has been an LLL Leader since 1981.Page last edited 2007-10-14 09:30:37 UTC.